[Congressional Record Volume 165, Number 96 (Monday, June 10, 2019)]
[Senate]
[Pages S3288-S3292]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Ms. COLLINS (for herself, Mr. Coons, Mr. Roberts, Ms. 
        Duckworth, Mr. Sullivan, Mr. Van Hollen, Mrs. Capito, Mr. 
        Markey, Mr. Isakson, Mr. Merkley, Mr. Moran, Mr. Cardin, Mr. 
        Cornyn, Ms. Rosen, Mr. Young, Ms. Stabenow, Mr. Enzi, Mr. 
        Wyden, Mr. Cramer, Mr. Murphy, Mr. Rubio, and Mr. Reed):
  S. 1766. A bill to implement policies to end preventable maternal, 
newborn, and child deaths globally; to the Committee on Foreign 
Relations.
  Ms. COLLINS. Mr. President, I rise this evening to introduce 
legislation with my friend and colleague from Delaware, Senator Chris 
Coons, called the Reach Every Mother and Child Act of 2019. I am 
delighted to say that we have 22 bipartisan cosponsors for our 
initiative. Our legislation would make it the policy of the United 
States to lead an effort to end preventable deaths of mothers, 
newborns, and young children in the developing world by the year 2030.
  Due in part to American leadership and generosity, many lives have 
already been saved. Since 1990, the annual number of deaths of children 
under the age of 5 has been cut in half. Nevertheless, far too many 
mothers, newborns, and young children under the age of 5 still succumb 
to disease and malnutrition that could easily have been prevented.
  Every day, approximately 800 women die from preventable causes that 
are related to pregnancy and childbirth. In addition, more than 15,000 
children under the age of 5 die every day from treatable conditions, 
such as prematurity, pneumonia, and diarrhea, with malnutrition being 
the underlying cause in nearly half of those deaths.
  Our bill aims to reach these mothers and children with simple, 
proven, cost-effective interventions that we know will help them 
survive. A concentrated effort could end preventable maternal and child 
deaths worldwide by the year 2030. However, continued American 
leadership and support from the international community are critical to 
success.
  To achieve this ambitious goal, our bill would require the 
implementation of a strategy to scale up the most effective 
interventions to save as many lives as possible. This idea is central 
to our bill. We do not have to guess at what interventions will work. 
The reality is that more than 15,000 children die each day of 
conditions that we know how to treat right now. These lifesaving 
interventions include clean birthing practices, vaccines, nutritional 
supplements, handwashing with soap, and other basic needs that remain 
elusive for far too many women and children in developing countries. 
This is what must change.
  In addition, our bill would establish a Maternal and Child Survival 
Coordinator at the USAID, who would focus on implementing the 5-year 
strategy and verifying that the most effective interventions are being 
scaled up in target countries.
  The bill would improve government efficiency across several agencies 
that would collaborate with the Coordinator to identify and promote the 
most effective treatments to end preventable maternal and child deaths 
globally. To promote transparency and greater accountability, our bill 
would also require detailed public reporting on progress toward 
implementing this strategy.
  Finally, our legislation would encourage the USAID to help pay for 
successful programs that are run by nongovernmental entities. The 
message that we want to send to all of our partners in the private 
sector, the nonprofit sector, the faith community, and in local and 
international civil society groups is this: If you can figure out an 
effective way to increase the likelihood that mothers and their 
children will survive childbirth in those first 5 vulnerable years of 
life, we want to acknowledge your contributions.
  We realize that the government does not have all of the answers and 
that if we and our partners in the private sector all work together, 
whether they be nonprofits, foundations, the faith community, local and 
international government-sponsored organizations, or civil society 
groups, we can solve this problem.
  Improving the health and well-being of mothers and children around 
the world have far-reaching social and economic benefits as well. The 
USAID estimates and identifies examples of the return on our 
investments in numerous priority countries. For example, in 
Afghanistan, Haiti, Liberia, Nepal, South Sudan, Rwanda, and Yemen, the 
USAID estimates that its health investments may yield a 9-to-1 return 
in economic and societal benefits by the year 2035.
  The USAID also estimates its return on investment in the form of 
resources mobilized, which is a measure based on additional dollar 
investments that are made by country governments or local organizations 
or by cost savings within a health system from increased efficiencies. 
In Senegal, for example, the USAID estimates $204 million in resources 
mobilized by 2025, which is a 656-to-1 return on the USAID's 
investment. In India, it estimates that a $25.5 billion investment by 
the year 2025 is a striking nearly 3,000-to-1 return on the USAID's 
investment.
  Other bipartisan initiatives, such as the successful President's 
Emergency Plan for AIDS Relief, or PEPFAR, which was started by 
President George W. Bush, demonstrate that results-driven interventions 
can turn the tide for global health challenges. In applying lessons 
learned from past initiatives, our bill would provide the focus and the 
tools necessary to accelerate progress toward a goal that we should all 
be able to embrace, which is to end preventable maternal and child 
deaths.
  I urge my colleagues to join with Senator Coons and me and our 22 
cosponsors in supporting this legislation that will literally save the 
lives of mothers and children around the world by doing what we know 
works.
                                 ______
                                 
      By Mr. DURBIN (for himself, Mrs. Capito, Ms. Duckworth, and Ms. 
        Murkowski):
  S. 1770. A bill to improve the identification and support of children 
and families who experience trauma; to the Committee on Health, 
Education, Labor, and Pensions.
  Mr. DURBIN. Mr. President, I ask unanimous consent that the text of 
the bill be printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1770

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Resilience Investment, 
     Support, and Expansion from Trauma Act'' or the ``RISE from 
     Trauma Act''.

                     TITLE I--COMMUNITY PROGRAMMING

     SEC. 101. TRAUMA-RELATED COORDINATING BODIES.

       Title V of the Public Health Service Act is amended by 
     inserting after section 520A (42 U.S.C. 290bb-32) the 
     following:

     ``SEC. 520B. TRAUMA-RELATED COORDINATING BODIES TO ADDRESS 
                   COMMUNITY TRAUMA.

       ``(a) Grants.--
       ``(1) In general.--The Secretary, acting through the 
     Assistant Secretary, shall award grants to State, county, 
     local, or Indian tribe or tribal organizations (as such terms 
     are defined in section 4 of the Indian Self-Determination Act 
     and Education Assistance Act) or nonprofit private entities 
     for demonstration projects to enable such entities to act as 
     coordinating bodies to address community trauma.

[[Page S3289]]

       ``(2) Amount.--The Secretary shall award such grants in 
     amounts of not more than $4,000,000.
       ``(3) Duration.--The Secretary shall award such grants for 
     periods of 4 years.
       ``(b) Eligible Entities.--
       ``(1) In general.--To be eligible to receive a grant under 
     this section, an entity shall include 1 or more 
     representatives of each of the categories described in 
     paragraph (2).
       ``(2) Composition.--The categories referred to in paragraph 
     (1) are--
       ``(A) governmental agencies, such as public health, human 
     services, or child welfare agencies, that conduct activities 
     to screen, assess, provide services or referrals, prevent, or 
     provide treatment to support infants, children, youth, and 
     their families as appropriate, that have experienced or are 
     at risk of experiencing trauma;
       ``(B) faculty or qualified staff at an institution of 
     higher education (as defined in section 101(a) of the Higher 
     Education Act of 1965) or representatives of a member of the 
     National Child Traumatic Stress Network, in an area related 
     to screening, assessment, service provision or referral, 
     prevention, or treatment to support infants, children, youth, 
     and their families, as appropriate, that have experienced or 
     are at risk of experiencing trauma;
       ``(C) hospitals, health care clinics, or other health care 
     institutions, such as mental health and substance use 
     treatment facilities;
       ``(D) criminal justice representatives related to adults 
     and juveniles, which may include law enforcement or judicial 
     or court employees;
       ``(E) local educational agencies or agencies responsible 
     for early childhood education programs, which may include 
     Head Start and Early Head Start agencies;
       ``(F) community-based faith, human services, or social 
     services organizations, including providers of after-school 
     programs, home visiting programs, agencies that serve victims 
     of domestic and family violence and child sexual abuse, or 
     programs to prevent or address the impact of violence and 
     addiction; and
       ``(G) the general public, including individuals who have 
     experienced trauma.
       ``(3) Qualifications.--In order for an entity to be 
     eligible to receive the grant under this section, the 
     representatives included in the entity shall, collectively, 
     have professional training and expertise concerning childhood 
     trauma and evidence-based, evidence-informed, and promising 
     best practices to prevent and mitigate the impact of exposure 
     to trauma.
       ``(c) Application.--To be eligible to receive a grant under 
     this section, an entity shall submit an application to the 
     Secretary at such time, in such manner, and containing such 
     information as the Secretary may require, including 
     information describing how the coordinating body funded under 
     the grant will continue its activities after the end of the 
     grant period.
       ``(d) Priority.--In awarding grants under this section, the 
     Secretary shall give priority to entities proposing to serve 
     communities that have faced high rates of community trauma, 
     including from intergenerational poverty, civil unrest, 
     discrimination, or oppression, which may include an 
     evaluation of--
       ``(1) an age-adjusted rate of drug overdose deaths that is 
     above the national overdose mortality rate, as determined by 
     the Director of the Centers for Disease Control and 
     Prevention; and
       ``(2) an age-adjusted rate of violence-related (or 
     intentional) injury deaths that is above the national 
     average, as determined by the Director of the Centers for 
     Disease Control and Prevention.
       ``(e) Use of Funds.--An entity that receives a grant under 
     this section to act as a coordinating body shall use the 
     grant funds--
       ``(1) to bring together stakeholders who provide or use 
     services in, or have expertise concerning, covered settings 
     to identify community needs and resources related to services 
     to prevent or address the impact of trauma, and to build on 
     any needs assessments conducted by organizations or groups 
     represented on the coordinating body;
       ``(2)(A) to collect data, on indicators specified by the 
     Secretary, that covers multiple covered settings; and
       ``(B) to use the data to identify unique community 
     challenges and barriers, gaps in services, and high-need 
     areas, related to services to prevent or address the impact 
     of trauma;
       ``(3) to build awareness, skills, and leadership (including 
     through trauma-informed training and public outreach 
     campaigns) related to implementing the best practices 
     developed under section 7132(d) of the SUPPORT for Patients 
     and Communities Act (Public Law 115-271) (referred to in this 
     subsection as the `developed best practices'); and
       ``(4) to develop a strategic plan that identifies--
       ``(A) policy goals and coordination opportunities 
     (including coordination in applying for grants) relating to 
     implementing the developed best practices; and
       ``(B) a comprehensive, integrated approach for the entity 
     and its members to prevent and mitigate the impact of 
     exposure to trauma in the community, and to assist the 
     community in healing from existing and prior exposure to 
     trauma.
       ``(f) Supplement Not Supplant.--Amounts made available 
     under this section shall be used to supplement and not 
     supplant other Federal, State, and local public funds and 
     private funds expended to provide trauma-related coordination 
     activities.
       ``(g) Evaluation.--At the end of the period for which 
     grants are awarded under this section, the Secretary shall 
     conduct an evaluation of the activities carried out under 
     each grant under this section. In conducting the evaluation, 
     the Secretary shall assess the outcomes of the grant 
     activities carried out by each grant recipient.
       ``(h) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $50,000,000 for 
     the period of fiscal years 2020 through 2023.
       ``(i) Definition.--In this section, the term `covered 
     setting' means the settings in which individuals may come 
     into contact with infants, children, youth, and their 
     families, as appropriate, who have experienced or are at risk 
     of experiencing trauma, including schools, hospitals, 
     settings where health care providers, including primary care 
     and pediatric providers, provide services, early childhood 
     education and care settings, home visiting settings, after-
     school program facilities, child welfare agency facilities, 
     public health agency facilities, mental health treatment 
     facilities, substance use treatment facilities, faith-based 
     institutions, domestic violence agencies, child advocacy 
     centers, homeless services system facilities, refugee 
     services system facilities, juvenile justice system 
     facilities, law enforcement agency facilities, Healthy 
     Marriage Promotion or Responsible Fatherhood service 
     settings, child support service settings, and service 
     settings focused on individuals eligible for Temporary 
     Assistance for Needy Families.''.

     SEC. 102. EXPANSION OF PERFORMANCE PARTNERSHIP PILOT FOR 
                   CHILDREN WHO HAVE EXPERIENCED OR ARE AT RISK OF 
                   EXPERIENCING TRAUMA.

       Section 526 of the Departments of Labor, Health and Human 
     Services, and Education, and Related Agencies Appropriations 
     Act, 2014 (42 U.S.C. 12301 note) is amended--
       (1) in subsection (a), by adding at the end the following:
       ``(4) `To improve outcomes for infants, children, and 
     youth, and their families as appropriate, who have 
     experienced or are at risk of experiencing trauma' means to 
     increase the rate at which individuals who have experienced 
     or are at risk of experiencing trauma, including those who 
     are low-income, homeless, involved with the child welfare 
     system, involved in the juvenile justice system, unemployed, 
     or not enrolled in or at risk of dropping out of an 
     educational institution and live in a community that has 
     faced acute or long-term exposure to substantial 
     discrimination, historical oppression, intergenerational 
     poverty, civil unrest, a high rate of violence or drug 
     overdose deaths, achieve success in meeting educational, 
     employment, health, developmental, community reentry, 
     permanency from foster care, or other key goals.'';
       (2) in subsection (b)--
       (A) in the subsection heading, by striking ``Fiscal Year 
     2014'' and inserting ``Fiscal Years 2020 Through 2024'';
       (B) by redesignating paragraphs (1) and (2) as 
     subparagraphs (A) and (B), respectively, and by moving such 
     subparagraphs, as so redesignated, 2 ems to the right;
       (C) by striking ``Federal agencies'' and inserting the 
     following:
       ``(1) Disconnected youth pilots.--Federal agencies''; and
       (D) by adding at the end the following:
       ``(2) Trauma-informed care pilots.--
       ``(A) In general.--Federal agencies may use Federal 
     discretionary funds that are made available in this Act or 
     any appropriations Act for any of fiscal years 2020 through 
     2024 to carry out up to 10 Performance Partnership Pilots. 
     Such Pilots shall:
       ``(i) be designed to improve outcomes for infants, 
     children, and youth, and their families as appropriate, who 
     have experienced or are at risk of experiencing trauma; and
       ``(ii) involve Federal programs targeted on infants, 
     children, and youth, and their families as appropriate, who 
     have experienced or are at risk of experiencing trauma.
       ``(B) Priority.--In making funds available under this 
     paragraph, a Federal agency shall give priority to entities 
     that receive grants under section 520B of the Public Health 
     Service Act.'';
       (3) in subsection (c)(2)--
       (A) in subparagraph (A), by striking ``2018'' and inserting 
     ``2023''; and
       (B) in subparagraph (F), by inserting before the semicolon 
     ``, including the age range for such population''; and
       (4) in subsection (e), by striking ``2018'' and inserting 
     ``2023''.

     SEC. 103. NATIONAL AND COMMUNITY SERVICE.

       (a) Service-Learning.--Section 113(a)(2) of the National 
     and Community Service Act of 1990 (42 U.S.C. 12525(a)(2)) is 
     amended--
       (1) in subparagraph (C), by striking ``and'' at the end;
       (2) in subparagraph (D), by striking the period and 
     inserting ``, and''; and
       (3) by adding at the end the following:
       ``(E) information describing how the applicant will give 
     priority, in reviewing applications under subsection (b), to 
     entities that propose service-learning programs in 
     communities with high levels of trauma (as defined in section 
     520B of the Public Health Service Act).''.

[[Page S3290]]

       (b) Americorps Recruitment.--Section 130(b)(5) of the 
     National and Community Service Act of 1990 (42 U.S.C. 
     12582(b)(5)) is amended by inserting after ``and women,'' the 
     following: ``and to give priority (to the maximum extent 
     practicable) to recruitment of participants from communities 
     with high levels of trauma (as defined in section 520B of the 
     Public Health Service Act),''.
       (c) Americorps State Programs.--Section 130(c) of the 
     National and Community Service Act of 1990 (42 U.S.C. 
     12582(c)) is amended by adding at the end the following:
       ``(4) In the case of a State or territory described in 
     section 129(e), an assurance that the State or territory, in 
     distributing grant funds made available under that section, 
     will give priority to entities proposing national service 
     programs that are related to the provision of trauma-informed 
     services in communities with high levels of trauma (as 
     defined in section 520B of the Public Health Service Act).''.
       (d) Americorps Competitive Programs.--Section 133(d)(2) of 
     the National and Community Service Act of 1990 (42 U.S.C. 
     12585(d)(2)) is amended--
       (1) in subparagraph (B), by striking ``and'' at the end;
       (2) in subparagraph (C), by striking the period and 
     inserting ``; and''; and
       (3) by adding at the end the following:
       ``(D) national service programs that are related to the 
     provision of trauma-informed services in communities with 
     high levels of trauma (as defined in section 520B of the 
     Public Health Service Act).''.

     SEC. 104. HOSPITAL-BASED INTERVENTIONS TO REDUCE 
                   READMISSIONS.

       Section 911 of the Public Health Service Act (42 U.S.C. 
     299b) is amended by adding at the end the following:
       ``(c) Hospital-based Interventions to Reduce 
     Readmissions.--
       ``(1) Grants.--The Secretary, acting through the Director 
     of the Agency, shall award grants to eligible entities to 
     evaluate hospital-based interventions to reduce subsequent 
     readmissions of patients that present at a hospital after 
     overdosing, attempting suicide, or suffering violent injury 
     or abuse.
       ``(2) Eligible entities.--To be eligible to receive a grant 
     under this subsection and entity shall--
       ``(A) be a hospital or health system (including health 
     systems operated by Indian tribes or tribal organizations as 
     such terms are defined in section 4 of the Indian Self-
     Determination Act and Education Assistance Act); and
       ``(B) submit to the Secretary an application at such time, 
     in such manner, and containing such information as the 
     Secretary may require, which shall include demonstrated 
     experience furnishing successful hospital-based trauma 
     interventions to improve outcomes for patients presenting 
     after overdosing, attempting suicide, or suffering violent 
     injury or abuse.
       ``(3) Use of funds.--An entity shall use amounts received 
     under a grant under this subsection to test and evaluate 
     hospital-based trauma-informed interventions for patients who 
     present at hospitals with drug overdoses, suicide attempts, 
     and violent injuries (such as domestic violence or 
     intentional penetrating wounds, including gunshots and 
     stabbings) to provide comprehensive education, screening, 
     counseling, discharge planning, skills building, and long-
     term case management services to prevent hospital 
     readmission, injury, and improve health and safety outcomes. 
     Such interventions may be furnished in coordination or 
     partnership with qualified community-based organizations and 
     may include or incorporate the best practices developed under 
     section 7132(d) of the SUPPORT for Patients and Communities 
     Act (Public Law 115-271).
       ``(4) Quality measures.--An entity that receive a grant 
     under this section shall submit to the Secretary a report on 
     the data and outcomes developed under the grant, including 
     any quality measures developed to prevent hospital 
     readmissions for the patients served under the program 
     involved.''.

     SEC. 105. SUPPORTING AT-RISK AND TRAUMA-EXPOSED STUDENTS WITH 
                   ARTS OPPORTUNITIES.

       Section 5(c) of the National Foundation on the Arts and 
     Humanities Act of 1965 (20 U.S.C. 954(c)) is amended--
       (1) in paragraph (9), by striking ``and'' at the end;
       (2) in paragraph (10), by striking the period and inserting 
     ``; and''; and
       (3) by inserting after paragraph (10), the following:
       ``(11) projects, programs, and workshops that provide 
     therapy and creative expression opportunities through the 
     arts for children, and their families as appropriate, who 
     have experienced or are at risk of experiencing trauma.''.

     SEC. 106. ENSURING PARITY FOR INFANT, EARLY CHILDHOOD, AND 
                   YOUTH MENTAL HEALTH.

       Part K of title V of the Public Health Service Act (42 
     U.S.C. 290ll et seq.) is amended--
       (1) by redesignating section 550 (42 U.S.C. 290ee-10), 
     relating to sobriety treatment and recovery teams, as section 
     598; and
       (2) by adding at the end the following:

     ``SEC. 599. INFANT AND EARLY CHILDHOOD MENTAL HEALTH PARITY.

       ``(a) In General.--The Secretary, in coordination with the 
     Secretary of Labor and the Secretary of Education, shall 
     award grants to, or enter into cooperative agreements with, 
     States to ensure that health insurance issuers in the State 
     comply with section 2726, as such section applies to infant 
     and early childhood mental and behavioral health.
       ``(b) Use of Grant.--A State shall use amounts received 
     under a grant or cooperative agreement under this section 
     to--
       ``(1) establish clear guidelines for parity compliance for 
     infant and early childhood mental health that are evidence-
     based;
       ``(2) align parity compliance with best practices for 
     meeting an infant's Individualized Family Service Plan under 
     part C of the Individuals with Disabilities Education Act or 
     a preschool aged child's Individualized Education Plan under 
     part B of such Act, as well as providing Coordinated Early 
     Intervening Services under part B of such Act to preschool 
     age children;
       ``(3) engage with health insurance issuers to ensure that 
     they comply with the guidelines promulgated and other 
     provisions of section 2726, as such section applies to infant 
     and early childhood mental health;
       ``(4) ensure health insurance issuer compliance through 
     audits, market conduct examinations, secret shopper programs, 
     or other means;
       ``(5) share learnings with other States who receive grants 
     under this section; and
       ``(6) submit a report to the Secretary, the Secretary of 
     Labor, and the Secretary of Education, on findings, actions, 
     recommendations, and any such other information as such 
     Secretaries shall require.
       ``(c) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $10,000,000 for 
     each of fiscal years 2020 through 2024.''.

     SEC. 107. STREAMLINING AND COORDINATING TRAUMA GRANT FUNDING.

       Not later than 2 years after the date of enactment of this 
     Act, the Director of the Office of Management and Budget, in 
     coordination with the Task Force created under section 7132 
     of the SUPPORT for Patients and Communities Act (Public Law 
     115-271), shall review the Federal grant programs and funding 
     streams with relevance or potential to furnish the best 
     practices developed under section 7132(d) of such Act for 
     preventing and mitigating the impact of trauma, and issue 
     guidance to agencies on the following:
       (1) Aligning measurement, reporting, and timelines for 
     Federal funds used to address community trauma.
       (2) Leveraging different Federal funding streams to enable 
     effective data sharing, integration, and privacy to support 
     coordination for addressing community trauma.
       (3) Consistency in eligibility requirements and enrollment 
     pathways for Federal funding to facilitate strategies for 
     addressing community trauma.
       (4) Support for community-level planning activities that 
     advance the overall policy goals of each Federal funding 
     stream.
       (5) Modeling the long-term budgetary benefits of preventing 
     or mitigating community trauma.
       (6) The inclusion of trauma impact statements within 
     relevant grants focused on serving children and families.

     SEC. 108. MEASURING SAVINGS FROM TRAUMA-INFORMED 
                   INTERVENTIONS.

       (a) Identification of Effective Interventions.--The 
     Secretary of Health and Human Services, acting through the 
     Assistant Secretary for Planning and Evaluation, and in 
     coordination with the Attorney General, the Secretary of 
     Education, and the Secretary of Labor, shall conduct a review 
     and analysis of the best practices developed under section 
     7132(d) of the SUPPORT for Patients and Communities Act 
     (Public Law 115-271) (referred to in this section as the 
     ``developed best practices'') that can be furnished through a 
     Federal grant or health insurance program to prevent and 
     mitigate the impact of trauma among infants, children, and 
     youth, and their families, as appropriate, and identify those 
     practices which hold the most promise to reduce long-term 
     costs and spending associated with children, including health 
     care and child welfare costs.
       (b) Conduct of Review.--In conducting the review and 
     analysis under subsection (a), the Assistant Secretary may--
       (1) solicit public input on the review design, findings, 
     and conclusions; and
       (2) examine methods for evaluating whether the developed 
     best practices were effectively implemented and the predicted 
     outcomes and savings are likely to be achieved, which may 
     include competency and testing approaches, and performance or 
     outcome measures.
       (c) Updates.--The set of best practices identified under 
     subsection (a) as holding promise to reduce costs shall be 
     updated at regular intervals.
       (d) Evaluating Long-Term Savings Associated With the 
     Interventions.--The Director of the Office of Management and 
     Budget shall analyze, determine, and publicly report the 
     cost-savings across the Federal budget over 20 years, 
     including an appropriate discount rate, associated with the 
     effective implementation of the interventions identified in 
     subsection (a), when applied in a representative population 
     of children participating in all such appropriate Federal 
     grant or health insurance programs in a given year, and 
     update these determinations at least every 5 years.

                    TITLE II--WORKFORCE DEVELOPMENT

     SEC. 201. DIVERSITY TRAINING FOR INDIVIDUALS FROM COMMUNITIES 
                   THAT HAVE EXPERIENCED HIGH LEVELS OF TRAUMA, 
                   VIOLENCE, OR ADDICTION.

       Part B of title VII of the Public Health Service Act (42 
     U.S.C. 293 et seq.) is amended by adding at the end the 
     following:

[[Page S3291]]

  


     ``SEC. 742. INDIVIDUALS FROM COMMUNITIES THAT HAVE 
                   EXPERIENCED HIGH LEVELS OF TRAUMA, VIOLENCE, OR 
                   ADDICTION.

       ``In carrying out activities under this part, the Secretary 
     shall ensure that emphasis is provided on the recruitment of 
     individuals from communities that have experienced high 
     levels of trauma, violence, or addiction and that appropriate 
     activities under this part are carried out in partnership 
     with community-based organizations that have expertise in 
     addressing such challenges to enhance service delivery.''.

     SEC. 202. FUNDING FOR THE NATIONAL HEALTH SERVICE CORPS.

       Section 10503(b)(2) of the Patient Protection and 
     Affordable Care Act (42 U.S.C. 254b-2(b)(2)) is amended--
       (1) in subparagraph (E), by striking ``and'' at the end;
       (2) in subparagraph (F), by striking the period and 
     inserting ``; and''; and
       (3) by adding at the end the following:
       ``(G) $360,000,000 for each of fiscal years 2020 through 
     2024.''.

     SEC. 203. INFANT AND EARLY CHILDHOOD CLINICAL WORKFORCE.

       Part P of title III of the Public Health Service Act (42 
     U.S.C. 280g) is amended by adding at the end the following:

     ``SEC. 399V-7. INFANT AND EARLY CHILDHOOD CLINICAL WORKFORCE.

       ``(a) In General.--The Secretary, acting through the 
     Associate Administrator of the Maternal and Child Health 
     Bureau, shall establish an Infant and Early Childhood 
     Clinical Mental Health Leadership Program to award grants to 
     eligible entities to establish training institutes and 
     centers of excellence for infant and early childhood clinical 
     mental health.
       ``(b) Eligible Entities.--To be eligible to receive a grant 
     under this section, an entity shall--
       ``(1) be--
       ``(A) an institution of higher education as defined in 
     section 101(a) of the Higher Education Act of 1965; or
       ``(B) be a hospital with affiliation with such an 
     institution of higher education, or a State professional 
     medical society or association of infant mental health 
     demonstrating an affiliation or partnership with such an 
     institution of higher education; and
       ``(2) submit to the Secretary an application at such time, 
     in such manner, and containing such information as the 
     Secretary may require.
       ``(c) Use of Grant.--An entity shall use amounts received 
     under a grant under this section to establish statewide 
     training institutes or centers of excellence for licensed 
     clinical social workers, licensed professional counselors, 
     licensed marriage and family therapists, clinical 
     psychologists, child psychiatrists, school psychologists, 
     nurses, and developmental and behavioral pediatricians on 
     infant and early childhood clinical mental health, with an 
     emphasis on screening, assessment, service provision or 
     referral, prevention, and treatment for infants and children 
     who have experienced or are at risk of experiencing trauma, 
     as well as prevention of secondary trauma, through--
       ``(1) the provision of community-based training and 
     supervision in evidence-based assessment, diagnosis, and 
     treatment, which may be conducted through partnership with 
     qualified community-based organizations;
       ``(2) the development of graduate education training 
     tracks;
       ``(3) the provision of scholarships and stipends, including 
     to enhance recruitment from under-represented populations in 
     the mental health workforce; and
       ``(4) the provision of mid-career training to develop the 
     capacity of existing health practitioners.
       ``(d) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $25,000,000 for 
     each of fiscal years 2020 through 2024.''.

     SEC. 204. TRAUMA-INFORMED TEACHING AND SCHOOL LEADERSHIP.

       (a) Partnership Grants.--Section 202 of the Higher 
     Education Act of 1965 (20 U.S.C. 1022a) is amended--
       (1) in subsection (b)(6)--
       (A) by redesignating subparagraphs (H) through (K) as 
     subparagraphs (I) through (L), respectively; and
       (B) by inserting after subparagraph (G) the following:
       ``(H) how the partnership will prepare general education 
     and special education teachers, including early childhood 
     educators, to support positive learning outcomes and social 
     and emotional development for students who have experienced 
     trauma (including students who are involved in the foster 
     care or juvenile justice systems or runaway or homeless 
     youth) and in alternative education settings in which high 
     populations of youth with trauma exposure may learn 
     (including settings for correctional education, juvenile 
     justice, pregnant and parenting students, or youth who have 
     re-entered school after a period of absence due to dropping 
     out);'';
       (2) in subsection (d)(1)(A)(i)--
       (A) in subclause (II), by striking ``and'' after the 
     semicolon;
       (B) by redesignating subclause (III) as subclause (IV); and
       (C) by inserting after subclause (II) the following:

       ``(III) such teachers, including early childhood educators, 
     to adopt evidence-based approaches for improving behavior 
     (such as positive behavior interventions and supports and 
     restorative justice), supporting social and emotional 
     learning, mitigating the effects of trauma, improving the 
     learning environment in the school, preventing secondary 
     trauma, compassion fatigue, and burnout, and for alternatives 
     to suspensions, expulsions, corporal punishment, referrals to 
     law enforcement, and other actions that remove students from 
     the learning environment; and''; and

       (3) in subsection (d), by adding at the end the following:
       ``(7) Trauma-informed practice and work in alternative 
     education settings.--Developing the teaching skills of 
     prospective and, as applicable, new, early childhood, 
     elementary school, and secondary school teachers to adopt 
     evidence-based trauma-informed teaching strategies--
       ``(A) to--
       ``(i) recognize the signs of trauma and its impact on 
     learning;
       ``(ii) maximize student engagement and promote the social 
     and emotional development of students; and
       ``(iii) implement alternative practices to suspension and 
     expulsion that do not remove students from the learning 
     environment; and
       ``(B) including programs training teachers, including early 
     childhood educators, to work with students with exposure to 
     traumatic events (including students involved in the foster 
     care or juvenile justice systems or runaway and homeless 
     youth) and in alternative academic settings for youth unable 
     to participate in a traditional public school program in 
     which high populations of students with trauma exposure may 
     learn (such as students involved in the foster care or 
     juvenile justice systems, pregnant and parenting students, 
     runaway and homeless students, and other youth who have re-
     entered school after a period of absence due to dropping 
     out).''.
       (b) Administrative Provisions.--Section 203(b)(2) of the 
     Higher Education Act of 1965 (20 U.S.C. 1022b(b)(2)) is 
     amended--
       (1) in subparagraph (A), by striking ``and'' after the 
     semicolon;
       (2) in subparagraph (B), by striking the period at the end 
     and inserting ``; and''; and
       (3) by adding at the end the following:
       ``(C) to eligible partnerships that have a high-quality 
     proposal for trauma training programs for general education 
     and special education teachers, including early childhood 
     educators.''.
       (c) Grants for the Development of Leadership Programs.--
     Section 202(f)(1)(B) of the Higher Education Act of 1965 (20 
     U.S.C. 1022a(f)(1)(B)) is amended--
       (1) in clause (v), by striking ``and'' at the end;
       (2) in clause (vi), by striking the period and inserting 
     ``; and''; and
       (3) by adding at the end the following:
       ``(vii) identify students who have experienced trauma and 
     connect those students with appropriate school-based or 
     community-based interventions and services.''.

     SEC. 205. TOOLS FOR FRONT-LINE PROVIDERS.

       Not later than 18 months after the date of enactment of 
     this Act, the Secretary of Health and Human Services, in 
     coordination with appropriate stakeholders with subject 
     matter expertise which may include the National Child 
     Traumatic Stress Network, shall carry out activities to 
     develop accessible and easily understandable toolkits for use 
     by front-line service providers (including teachers, early 
     childhood educators, school leaders, mentors, social workers, 
     counselors, faith leaders, first responders, kinship 
     caregivers) for appropriately identifying, responding to, and 
     supporting infants, children, and youth, and their families, 
     as appropriate, who have experienced or are at risk of 
     experiencing trauma. Front-line service providers may also 
     include programs focused on adults whose children or who 
     themselves have experienced trauma, including programs 
     related to Healthy Marriage and Responsible Fatherhood, child 
     support, and Temporary Assistance to Needy Families. Such 
     toolkits shall incorporate best practices developed under 
     section 7132(d) of the SUPPORT for Patients and Communities 
     Act (Public Law 115-271), and include actions to build a 
     safe, stable, and nurturing environment for the infants, 
     children, and youth served in those settings, capacity 
     building, and strategies for addressing the impact of 
     secondary trauma, compassion fatigue, and burnout among such 
     front-line service providers.

     SEC. 206. CHILDREN EXPOSED TO VIOLENCE INITIATIVE.

       Title I of the Omnibus Crime Control and Safe Streets Act 
     of 1968 (34 U.S.C. 10101) is amended by adding at the end the 
     following:

    ``PART OO--CHILDREN EXPOSED TO VIOLENCE AND ADDICTION INITIATIVE

     ``SEC. 3051. GRANTS TO IDENTIFY AND SUPPORT CHILDREN EXPOSED 
                   TO VIOLENCE AND SUBSTANCE USE.

       ``(a) In General.--The Attorney General may make grants to 
     States, units of local government, Indian tribes and tribal 
     organizations (as such terms are defined in section 4 of the 
     Indian Self-Determination Act and Education Assistance Act), 
     and nonprofit organizations to reduce violence and substance 
     use by preventing exposure to trauma, violence, or substance 
     use and identifying and supporting infants, children, and 
     youth, and their families, as appropriate, exposed to trauma, 
     violence, or substance use.
       ``(b) Use of Funds.--A grant under subsection (a) may be 
     used to implement trauma-informed policies and practices that 
     support infants, children, youth, and their families, as 
     appropriate, by--

[[Page S3292]]

       ``(1) building public awareness and education, and 
     improving policies and practices;
       ``(2) providing training, tools and resources to develop 
     the skills and capacity of parents (including foster 
     parents), adult guardians, and professionals who interact 
     directly with infants, children, and youth, and their 
     families, as appropriate, in an organized or professional 
     setting, including through the best practices developed under 
     section 7132(d) of the SUPPORT for Patients and Communities 
     Act (Public Law 115-271); and
       ``(3) providing technical assistance to communities, 
     organizations, and public agencies on how to prevent and 
     mitigate the impact of exposure to trauma, violence, and 
     substance use.
       ``(c) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $11,000,000 for each of fiscal years 2020 through 2024.''.

     SEC. 207. ESTABLISHMENT OF LAW ENFORCEMENT CHILD AND YOUTH 
                   TRAUMA COORDINATING CENTER.

       (a) Establishment of Center.--
       (1) In general.--The Attorney General shall establish a 
     National Law Enforcement Child and Youth Trauma Coordinating 
     Center (referred to in this section as the ``Center'') to 
     provide assistance to adult- and juvenile-serving State, 
     local, and tribal law enforcement agencies (including those 
     operated by Indian tribes and tribal organizations as such 
     terms are defined in section 4 of the Indian Self-
     Determination Act and Education Assistance Act) in 
     interacting with infants, children, and youth who have been 
     exposed to violence or other trauma, and their families as 
     appropriate.
       (2) Age range.--The Center shall determine the age range of 
     infants, children, and youth to be covered by the activities 
     of the Center.
       (b) Duties.--The Center shall provide assistance to adult- 
     and juvenile-serving State, local, and tribal law enforcement 
     agencies by--
       (1) disseminating information on the best practices for law 
     enforcement officers, which may include best practices based 
     on evidence-based and evidence-informed models from programs 
     of the Department of Justice and the Office of Justice 
     Services of the Bureau of Indian Affairs or the best 
     practices developed under section 7132(d) of the SUPPORT for 
     Patients and Communities Act (Public Law 115-271), such as--
       (A) models developed in partnership with national law 
     enforcement organizations, Indian tribes, or clinical 
     researchers; and
       (B) models that include--
       (i) trauma-informed approaches to conflict resolution, 
     information gathering, forensic interviewing, de-escalation, 
     and crisis intervention training;
       (ii) early interventions that link child and youth 
     witnesses and victims, and their families as appropriate, to 
     age-appropriate trauma-informed services; and
       (iii) preventing and supporting officers who experience 
     secondary trauma;
       (2) providing professional training and technical 
     assistance; and
       (3) awarding grants under subsection (c).
       (c) Grant Program.--
       (1) In general.--The Attorney General, acting through the 
     Center, may award grants to State, local, and tribal law 
     enforcement agencies or to multi-disciplinary consortia to--
       (A) enhance the awareness of best practices for trauma-
     informed responses to infants, children, and youth who have 
     been exposed to violence or other trauma, and their families 
     as appropriate; and
       (B) provide professional training and technical assistance 
     in implementing the best practices described in subparagraph 
     (A).
       (2) Application.--Any State, local, or tribal law 
     enforcement agency seeking a grant under this subsection 
     shall submit an application to the Attorney General at such 
     time, in such manner, and containing such information as the 
     Attorney General may require.
       (3) Use of funds.--A grant awarded under this subsection 
     may be used to--
       (A) provide training to law enforcement officers on best 
     practices, including how to identify and appropriately 
     respond to early signs of trauma and violence exposure when 
     interacting with infants, children, and youth, and their 
     families, as appropriate; and
       (B) establish, operate, and evaluate a referral and 
     partnership program with trauma-informed clinical mental 
     health, substance use, health care, or social service 
     professionals in the community in which the law enforcement 
     agency serves.
       (d) Authorization of Appropriations.--There are authorized 
     to be appropriated to the Attorney General--
       (1) $6,000,000 for each of fiscal years 2020 through 2024 
     to award grants under subsection (c); and
       (2) $2,000,000 for each of fiscal years 2020 through 2024 
     for other activities of the Center.

     SEC. 208. NATIONAL INSTITUTES OF HEALTH REPORT ON TRAUMA.

       Not later than 1 year after the date of the enactment of 
     this Act, the Director of the National Institutes of Health 
     shall submit to Congress a report on the activities of the 
     National Institutes of Health with respect to trauma 
     (including trauma that stems from child abuse, exposure to 
     violence, addiction and substance use, and toxic stress) and 
     the implications of trauma for infants, children, and youth, 
     and their families, as appropriate. Such report shall 
     include--
       (1) the comprehensive research agenda of the National 
     Institutes of Health with respect to trauma;
       (2) the capacity, expertise, and review mechanisms of the 
     National Institutes of Health with respect to the evaluation 
     and examination of research proposals related to child 
     trauma, including coordination across institutes and centers 
     and inclusion of trauma impact statements within relevant 
     grants focused on serving children and families;
       (3) the relevance of trauma to other diseases, outcomes, 
     and domains;
       (4) strategies to link and analyze data from multiple 
     independent sources, including child welfare, health care 
     (including mental health care), law enforcement, and 
     education systems, to enhance research efforts and improve 
     health outcomes;
       (5) the efficacy of existing interventions, including 
     clinical treatment methods, child- and family-focused 
     prevention models, and community-based approaches, in 
     mitigating the effects of experiencing trauma and improving 
     health and societal outcomes; and
       (6) identification of gaps in understanding in the field of 
     trauma and areas of greatest need for further research 
     related to trauma.

                          ____________________